Chapter 9

SETTING IT OFF

"TRIGGERS"

So red wine gives you a headache? Or is it chocolate? Perhaps it's a combination of things. Most of us have tried to figure out just what it was that caused our last headache. Maybe you've been advised to keep a log of what you eat and drink to help you figure out what it is that gives you headaches.

 

    Now let's look at it a different way. Perhaps there are certain things that initiate a sympathetic response.  The sympathetic nervous system responds to any kind of threat, or insult.  It doesn't have to be some outrageous stressful event, it could be a glass of wine (too much alcohol is deadly, and your body knows it), or the preservatives in certain foods, or the cultures in aged cheeses.  Everybody responds, but not everybody has spindle fibers that reside within highly dysfunctional musculature.  And those who do have dysfunctional musculature don't have the same degree of dysfunction  in the same musculature from one day to the next.  So here comes a sympathetic response to an irritant, otherwise known as a "trigger". Depending on the posture of the spindle, and the particular muscle it resides in, for example, it could be in one or both temporalis' (headache on the side(s) of the head),  lateral pterygoids' (face), trapezius ( neck/shoulders),  or the sphenomandibularis, (which attaches just behind the eye, i.e., "occular" migraine). You begin to feel that familiar "tension" about your scalp and/or neck…that's the intrafusal fiber of one or more spindles tensing up. What headache you already had begins to get worse.  Ultimately, the worst may happen.  If the intrafusal fiber contorts or spasms, you would find yourself in exquisite pain and  possibly nauseous (humm, that's the definition of migraine).  It may seem to originate from one or both sides of the head (the temporalis), or behind the eyes or sinuses (lateral pterygoid), or from the back of the neck (trapezius), or behind your eye (sphenomadibularis).

 

    Get the idea? So you figure you must be allergic to red wine. Or was it the chocolate? Perhaps it's too much sugar. Chinese food. Spicy things. Dairy products. Too much sleep.  Not enough sleep. You name it, because it doesn't mattter, does it? (You didn't really think that wine, cheese, glare, etc. was painful, did you?)

 

    So as you can see from this explanation, I'm not saying that the intensity of intense jaw clenching directly causes migraine pain.  But just as hot, humid air is required for a tornado, chronic intense muscular contraction may be one of the foundational requirements to perpetuate chronic migraine pain.

 

    Once you understand what kind of condition your musculature (and their resident spindle fibers are in), the way they  react to "triggers" are not such a mystery. Now that my temporalis is not overly fatigued, I'm able to eat and drink whatever I want, and I don't get a headache.

 

    MENSTRUATION

 

    Why do you suppose something as natural as menstruation or ovulation "triggers" a headache?   Many women, who generally don't get headaches through the month, have headaches and/or migraines before, during, or after menstruation and/or ovulation. They're told it's hormones, a menstrual migraine, so hang in there. And if these headaches appear during pregnancy? "No pain medication for you, you're pregnant."

 

    Rapid changes in blood hormone levels is certainly a physiologically stressful event, causing  sleep pattern changes, mood swings, etc. Sure seems like an ideal scenario for the sympathetic nervous system to react to.  And who is it that responds?  Well, if the musculature is is already dysfunctional, those spindle fibers are at risk.  Although it takes several cycles to observe significant relief, about two thirds of "menstrual migraine" sufferers respond favorably to the NTI-tss.

 

    ACCIDENTS AND TRAUMA

 

    Sometimes, physical trauma to the neck can cause jaw clenching to initiate, or to intensify.  The cervical sympathetic ganglia (a group neurons from the sympathetic nervous system within the neck) has been shown to cause and maintain jaw muscle contraction. If injured, parafunctional jaw muscle activity may result, or pre-existing parafunction may intensify.  It may take days to weeks before the symptoms are realized from this enhanced activity, which usually complicates the diagnosis.  Did the accident really cause these chronic headaches?  If the accident was weeks ago, you can see how some patients may be accused of "faking it", due to a pending lawsuit?  Let's look an automobile accident, for example. Let's say two people are sitting in a car and get hit from behind, and it's not very hard, either. It's just enough for the car to need a little body work. The passenger is perfectly fine, while the driver starts getting terrible headaches. What's the difference? Perhaps the driver rarely or never had headaches before; but, by looking at her teeth, you see the tell-tale wear marks that she has had a history of grinding her teeth. Another possibility is that her teeth may look perfectly normal, but she has had a history of occasional headaches, prior to the accident. But not like now. Now she has intense headaches, all the time. The wear marks on her teeth (grinding), or her history of headaches (clenching), confirm a propensity for jaw muscle parafunction.  All it took was some traumatic event to set off a sympathetic response to intensify her pre-existing parafunction. Her passenger, who has no previous grinding or clenching  habit,  seems to be doing just fine. Unfortunately for the driver, she may develope and continue to experience headaches for years to come. She may be told she has had some kind of semi permanent brain or neck injury. If her clenching intensity isn't suppressed, her headaches may continue indefinitely. Of course she starts believing that maybe she really did have some sort of terrible injury. She will go through endless doctor visits, physical therapy, chiropractic visits, and possibly surgery with little relief. Patients like these are told they will now have to endure their conditions and learn to live with them. Take your settlements and be on your way.

 

    Be aware, that it is possible for injury to occur to the jaw joint (TMJ). Entire textbooks have been written on the treatment of such instances. Rarely will any type of mouth splint, by itself, cure the pain and headache from true TMJ injury. Most patients with a jaw joint injury require specialized physical therapy and, occasionally, surgery.

 

    Occasionally I'll see a patient who has been in an accident and has been through months of various treatments for headaches and jaw joint conditions. All of the treatment had been directed at the jaw joint, the doctors assuming that the jaw joint was damaged and the cause of the headaches. They'll have tried physical therapy, mouth splints, chiropractic care, and medications, but nothing to suppress the intensity of the clenching, the perpetuating cause of the headaches. Some patients have even undergone jaw joint surgery because the doctors had assumed that a TMJ injury must have been the cause of the headaches, since nothing else was working. Right after the surgery, the headaches stop, but four to six weeks later, the headaches come back. This makes sense...would you clench your teeth just after jaw joint surgery? Not me, ouch! I'd wait until my surgery healed a bit.

 

    Typically, these patients' symptoms will reduce significantly within days to weeks of using the NTI-tss. Ideally, they'll continue with their physical therapy and chiropractic care. As the NTI-tss suppress the intense muscle activity, the remaining symptoms (injured neck and shoulders, for example) can be successfully treated by the physical therapist and chiropractor.

 

    WEEKENDS AND HOLIDAYS

 

    My wife recalled that her headaches were actually worse on weekends and on holidays. Boy, was I relieved that I wasn't the only one with such symptoms! One doctor suggested that she was probably pulling the covers up over her eyes to avoid the light when she tried to sleep in on weekends. He said this created a build-up of carbon dioxide in the air she was breathing, which intensified her headache. She assured me that that couldn't be the case because she always slept in a room with black-out shades, so she never could tell if the sun was up or not. My wife and I shared another curious feature of our headache histories. A nap in the middle of the day seemed to help our headaches, but sleeping all night always made them worse, especially when we'd sleep in.

 

    Actually, the explanation for this is simple. Sleep is comprised of several different stages. Of particular interest are the several hours just before waking, as you are transitioning from deeper to lighter sleep.. This is when teeth grinding and clenching commonly occur. Headache sufferers are clenching their teeth during their dreams. When they awake, the temporalis muscles are fatigued and painful...morning headache. If they decide to stay in bed longer, they lengthen their total clenching time and, therefore, the headache is worse.

 

    Taking a nap during the middle of the day for some seems to relieve the headache. A nap provides continuous muscle relaxation, with little or no clenching time, therefore, the headache sometimes subsides. However, the longer the nap, the more likely clenching will occur with the accompanying headache!

 

    The medical community is aware that some type of activity during sleep is causing morning headaches, but their remedy is to medicate the pain. When I attended an orofacial pain (jaw and face pain) conference in February of 1994, a question was asked of a prominent headache specialist on what should be done for chronic morning headache sufferers. His reply? Have your patients set their alarms earlier and earlier, until they determine when they can awaken themselves before the headache starts. Once they've done that, take lots of aspirin and go back to bed!

 

    "I have had migraines for thirty years. I have gone to many "experts" and tried all the recommended drugs. Sometimes the side effects were worse than the migraines. The thought of having headaches the rest of my life was despairing. Since using the NTI-tss, I had not had a migraine. I feel like a new person. Thank you for my miracle!"  Sharon Goralewski, Rochester Hills, MI

 

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